Tuesday, April 8, 2008

7 - perforated ear drum

Perforated Eardrum Overview

Your eardrum (tympanic membrane) is a thin, oval layer deep in your ear canal. It helps protect your delicate middle and inner ear from the outside world.

It is called an eardrum because it looks and acts like a drum. The eardrum receives vibrations from the outer ear and transmits them to the small hearing bones, or ossicles, of the middle ear.

Because it is so thin, your eardrum can be ruptured or punctured. The hole exposes the middle and inner ear to damage or infection.

Perforated Eardrum Causes

  • Infection of the middle or outer ear is the most common cause of a ruptured eardrum.
    • Infections can be caused by viruses, bacteria, or fungi.
    • Infections increase the pressure behind your eardrum, stretching the drum and causing pain.

  • When your eardrum can no longer stretch, it bursts or tears.
    • Frequently, your pain gets better, because the pressure is now relieved. Sometimes, however, your pain can actually get worse.

  • Trauma can also cause perforation.
    • Blunt or penetrating trauma, such as from a fall on the side of your head or a stick that goes deep in your ear
    • Rapid changes in pressure, like with scuba diving or going up in an elevator too fast (see ear pain with scuba diving or ear squeeze)

  • You can rupture your eardrum in other ways.
    • Slaps to the ear, such as a fall while water skiing or a hand slap to the side of the head
    • Lightning blasts
    • Blast waves from gunshots, fireworks, and other loud noises
    • Changes in air pressure during flying or diving
    • Sharp objects or cotton-tipped swabs
    • Motor vehicle accidents
    • Falls
    • Sports injuries

Perforated Eardrum Symptoms

  • Pain is the most common symptom.
    • You may notice only some general discomfort.
    • You may notice immediate intense pain.
    • You may just feel as if something is not right with your ear.
  • Other common symptoms
    • Vertigo (spinning sensation)
    • Ringing
    • Buzzing
    • Roaring
    • Clicking
    • Hearing change or loss
    • Fluid or blood draining from your ear

When to Seek Medical Care

Call your doctor immediately if you have a ruptured eardrum and any of the following occur:

  • An uncontrolled spinning sensation
  • Difficulty walking
  • An abrupt change in your hearing
  • A change in your ability to taste foods
  • You accidentally put your ear under water

The following symptoms suggest a potentially life-threatening complication and require immediate medical evaluation:

  • Stiff neck
  • High fever
  • The worst headache of your life
  • Numbness or weakness in face, arms, or legs
  • Difficulty talking or opening mouth
  • Continued vomiting
  • Pain in the bone behind your ear
  • Abrupt change in vision
  • Difficulty staying awake

Exams and Tests

The doctor can diagnose eardrum rupture by doing a history and looking in your ear with an otoscope—a special magnifier with a light.

  • Occasionally, very small holes can be difficult to identify and may require further testing.
    • Tympanogram - A test that uses a short burst of air against your eardrum
    • Audiogram – A hearing test

Perforated Eardrum Treatment


Some large holes or nonhealing small holes require surgery.

  • Surgical procedures are performed with general anesthetics. Most people go home from the hospital or clinic on the same day.
    • An ear, nose, and throat specialist (otolaryngologist) may graft or patch your eardrum with paper, fat, muscle, or other material.
    • These materials act as a bridge, allowing the tympanic membrane to grow together.

Next Steps


Some causes of ruptured eardrums cannot be prevented or avoided. A little care can lower your risk.

  • Treat ear infections early.
  • Avoid flying or scuba diving if you have an upper respiratory tract infection.
  • If you must fly or dive, plug your nose and swallow to help equalize the pressure.
  • Never put anything in your ear.
  • Wear proper ear protection.


After a few weeks, you should notice no long-term symptoms.

Rarely, someone gets a dangerous infection that spreads into the brain or skull. This requires immediate hospitalization or surgery. Also, if you have symptoms of severe dizziness and vomiting, facial paralysis, or hearing loss, more extensive surgery of your inner or middle ear may be required instead of just patching the eardrum.

Synonyms and Keywords

ruptured eardrum, ruptured tympanic membrane, hole in eardrum, torn eardrum, bad ear, inner ear, perforated eardrum

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